How pMRI after a DCIS diagnosis can improve patient care

Preoperative breast MRI (pMRI) can improve the surgical management of patients with newly diagnosed pure ductal carcinoma in situ (DCIS), according to a new study published in Academic Radiology.

The study’s authors explored data from 373 women with newly diagnosed DCIS following a core needle biopsy (CNB) from 2004 to 2013 at a single institution. All patients were at least 18 years old, had no personal history of ipsilateral breast cancer and underwent surgical management within 180 days of the initial CNB. The mean patient age was 55.5 years old.

A total of 332 patients had pMRI, leaving 41 who did not. Reasons that a patient did not undergo pMRI after their diagnosis included: claustrophobia, a contrast allergy and an advanced age, among others. “No significant differences” were observed in the clinical features or DCIS pathology features of patients who did and did not undergo pMRI.

Overall, 30% of the pMRI patients had an additional CNB compared to just 7% of the patients who did not have pMRI. The pMRI group, however, had fewer total surgeries (1.2 per patients vs. 1.5 per patients). In addition, patients in the no-pMRI group were more than twice as likely to have more than one surgery.

Patients in this particular study’s pMRI group also had a “significantly higher rate of single successful breast conserving surgery (BCS)” and “a lower mean number of surgeries” than patients in previous studies.

“pMRI may improve the surgical management of DCIS at an academic institution that routinely performs pMRI for new breast cancer diagnoses, leading to higher success rates of first BCS and lower re-excision rates, without causing a rise in mastectomies or delays in surgical treatment,” wrote Diana L. Lam, MD, department of radiology at University of Washington School of Medicine in Seattle, and colleagues. “Further studies are needed to understand the impact of pMRI on both short and long-term outcomes across a variety of practice types.”